Active NPI
Kellie Konstantinidis, DT
- Developmental Therapist
- Bloomingdale, IL
National Provider Identifier
1073259743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 175 Raven LN
Bloomingdale, IL 60108-1450 - Phone
- (630) 973-3152
- NPI assigned
- May 6, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | IL | Primary |
Addresses
Primary practice location
175 Raven LN
Bloomingdale, IL 60108-1450
Mailing address
175 Raven LN
Bloomingdale, IL 60108-1450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1073259743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 RAVEN LN",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "601081450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 RAVEN LN",
"city": "BLOOMINGDALE",
"state": "IL",
"postal_code": "601081450",
"telephone_number": "630-973-3152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONSTANTINIDIS",
"first_name": "KELLIE",
"credential": "DT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-06",
"last_updated": "2022-05-06",
"certification_date": "2022-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomingdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.